This morning I attended the Innovation and Value Initiative’s (IVI’s) event on “Ensuring Equity in Implementation of IRA Drug Price Negotiations.” As the discussions went on, I began to believe that ensuring equity in the Inflation Reduction Act (IRA) negotiation process was too herculean.

To ensure equity would require…

• a system that was equitable at its foundation and that is not our starting point. We are a work in progress that is just starting to pull apart what is equity and how do we continuously drive towards improving.
• transparency in what data and evidence is being used to make decisions in the negotiations. What are therapeutic alternatives? How are they being compared?
• working with others in a way that didn’t aim to do so in a perfunctory way. Patient engagement would meet patients where they are and be far more accessible than it was in the listening sessions from signing up to the actual presentation. The Food and Drug Administration has many (hard) lessons learned and could be of assistance here.
• agreeing to outcomes that improve equity and the methods and metrics that drive toward those outcomes. Right now we have solutions but no real way to know if we’re hitting the mark.
• time. The staff at the Centers for Medicare & Medicaid Services (CMS) want to do the right thing.  I have no doubt that they want to ensure equity but the timeframes we’re working with are not conducive to incorporating all of the steps needed to have transparency, get the feedback, get the data that moves us closer to ensuring equity. Instead, we are on what feels like a hamster wheel of name drugs, negotiate, spit out drug prices and repeat.

So maybe the title of the meeting was a bit of a misnomer. Maybe just the concept of weaving equity into the discussions was the win. Seventy-five people in a room for half a day, talking about what could be and how.